One-month Postpartum Research Articles

Women’s experiences of being assisted by two midwives during the active second stage of labour: Secondary outcomes from the Oneplus trial

Background‘Collegial Midwifery Assistance’ (CMA) is a clinical practice aiming to reduce severe perineal trauma (SPT) during childbirth. This practice involves two midwives being present during the active second stage of labour rather than one, which is the case in standard care. The effectiveness of CMA was evaluated in the Oneplus trial and a 30% reduction in SPT was shown. AimThe aim was to investigate the experience of women who received the CMA intervention in the trial and to explore factors influencing their experiences. MethodsA cohort study using data from the Oneplus trial and a one-month postpartum follow-up questionnaire. Descriptive statistics, univariable and multivariable logistic regression analyses were performed. ResultsA total of 1050 women who received the CMA intervention responded to the questionnaire. Of these, 35.8% reported that they strongly agreed with feeling safe during the second stage of labour and 42.6% were inclined to have an additional midwife present at a subsequent birth. The intervention was favourably received by women who experienced fear of birth, who were non-native Swedish speakers, and had lower educational attainment. Furthermore, women were more positive towards CMA the longer the intervention lasted. ConclusionsThe results of this study suggest that the CMA intervention is accepted well by women and can be safely implemented into standard care. The duration of the CMA intervention was an important factor that influenced women’s experiences and should be used to guide future practice.

The impact of fear of childbirth on mode of delivery, postpartum mental health and breastfeeding: A prospective cohort study in Shanghai, China

BackgroundThe prevalence and impact of fear of childbirth (FOC) has not been sufficiently understood. We aimed to investigate the prevalence of FOC among Chinese population and its impact on mode of delivery, postpartum mental health and breastfeeding. MethodsWe conducted a prospective cohort study, wherein pregnant women in their third trimester who underwent antenatal assessments at Shanghai Changning Maternity and Infant Health Hospital between September 2020 and March 2021 were recruited. Sociodemographic data of the participants were gathered by self-administered questionnaire, and their FOC was assessed using the Wijma Delivery Expectancy Questionnaire. Participants were followed up to 42 days postpartum. Information regarding their modes of delivery was retrieved from medical records, and data regarding postpartum mental health symptoms and one-month postpartum breastfeeding were obtained through self-administered questionnaires. ResultsAmong 1287 participants, 461 (35.8 %) had high-level FOC (W-DEQ ≥ 66). Logistic regressions showed that women with high-level of FOC had higher rates of caesarean delivery on maternal request (CDMR) (aOR = 1.55, 95 % CI: 1.00–2.41, p = 0.049), a higher incidence of postpartum mental health symptoms (aOR = 1.68, 95 % CI: 1.09–2.59, p = 0.018), lower rates of one-month postpartum exclusive breastfeeding (aOR = 0.33, 95 % CI: 0.16–0.69, p = 0.003) and mixed feeding (aOR = 0.44, 95 % CI: 0.21–0.91, p = 0.028). LimitationsThe long-term implications of FOC beyond the immediate postpartum period were not explored in the study. ConclusionsHigh-level FOC during the third trimester was associated with increased CDMR and postpartum mental health symptoms and reduced breastfeeding establishment. These results underscore the significance of FOC screening and tailored interventions for affected women.

Physical and psychological recovery after vaginal childbirth with and without epidural analgesia: A prospective cohort study.

Enhanced recovery is the gold standard in modern perioperative management, including that for cesarean deliveries. However, qualitative and quantitative data on the physical and psychological recovery of women after vaginal childbirth are limited. Whether neuraxial labor analgesia influences postpartum recovery is unknown. Primiparous women anticipating a vaginal childbirth between January 2020 and May 2021 were enrolled. Women with major comorbidities or postpartum complications and those who underwent a cesarean delivery were excluded. Daily step count was measured using a wrist-worn activity tracker (FitbitTM Inspire HR) for 120 hours after vaginal childbirth. Subjective fatigue levels and health-related quality of life were assessed using the Multidimensional Fatigue Inventory (MFI) and EuroQol 5 Dimension 5 Level (EQ-5D-5L), respectively, at the 3rd trimester antenatal visit, on postpartum day 1 and 3, and at the one-month postpartum visit. Rest and dynamic pain scores and the location of pain were documented by participants during postpartum hospitalization. Among 300 women who were enrolled antenatally, 95 and 116 had a vaginal delivery without (NCB group) and with (EPL group) epidural analgesia, respectively. The median number of steps per 24 hours increased daily in both groups, and no significant difference was detected between the groups. Postpartum pain was mild overall, with median rest and dynamic pain scores being less than 4 and similar between the groups. MFI and EQ-5D-5L scores were the worst on postpartum day 1 in both groups and gradually improved to antepartum level by the one-month postpartum visit. Higher MFI score on postpartum day 1, but not the use of epidural analgesia, was associated with lower odds of achieving adequate postpartum ambulation (defined as >3500 steps between 48 and 72 hours postpartum). The use of epidural analgesia was not associated with worse recovery outcomes during postpartum hospitalization. UMIN-CTR, #UMIN000039343, registered on January 31, 2020.

Care provided by midwives and the unmet needs of pregnant and postpartum women: A qualitative study of Japanese mothers

ObjectivesWe aimed to clarify the content of care provided by midwives working in hospitals and clinics in Japan and the unmet needs in midwifery care from mothers’ perspectives. DesignThis study employed a qualitative approach through semi-structured interviews. SettingFifteen Japanese women, whose youngest singleton children were aged 12–18 months, were asked to recall their experiences with midwives, from pregnancy through the first postpartum year. Verbatim records were analyzed using thematic analysis. ResultsSeven themes regarding the care provided by midwives were generated: confirmation of physical condition, maintenance and promotion of perinatal physiological process, support for better preparation for childbirth, assistance in labour and childbirth, support for a new life with a baby at home, support for the family, and care for comfort and confidence as a mother. Unmet needs were identified in all themes, except for ‘confirmation of physical condition’ and ‘support for the family’. Ten subthemes, under the five themes of unmet needs, were integrated into three categories: midwives’ responses to potential concerns, lack of continuity of care, and lack of personalised care. Key conclusions and implications for practiceMidwives in hospitals and clinics in Japan mainly provided care from pregnancy to one-month postpartum, in line with global core competencies. However, they could respond more effectively to the potential concerns of women, and provide continuous, personalised care more sufficiently. Improving working environments for midwives and collaborating with postpartum public health services are key to addressing these unmet needs of women, leading to women-centred care.

Association of severe maternal morbidity with bonding impairment and self-harm ideation: A multicenter prospective cohort study

BackgroundEvidence on the association between severe maternal morbidity (SMM) and mother-infant bonding and self-harm ideation is limited. We aimed to examine these associations and the mediating effect of Neonatal Intensive Care Unit (NICU) admission at one-month postpartum. MethodsThis multicenter, prospective cohort study was conducted in Japan (n = 5398). SMM included preeclampsia, eclampsia, severe postpartum hemorrhage, placental abruption, and a ruptured uterus. Lack of affection (LA) and Anger and Rejection (AR) were assessed using the Mother-Infant Bonding Scale (MIBS), and self-harm ideation was assessed using the 10th item of the Edinburgh Postnatal Depression Scale (EPDS). Linear and logistic regression models were used to examine the association between SMM and MIBS score and self-harm ideation. A structural equation model (SEM) was employed to examine the mediating effect of NICU admission on the association between SMM and mother-infant bonding and postpartum depressive symptoms. ResultsWomen with SMM had a 0.21 (95 % confidence interval [CI]: 0.03–0.40) point higher MIBS score and a decreasing trend in the risk of self-harm ideation (odds ratio 0.28, 95 % CI: 0.07–1.14) compared to those without SMM. SEM analysis revealed that SMM was associated with MIBS partially through NICU admission. LimitationsEPDS scores during pregnancy could be an unmeasured confounder. ConclusionsWomen with SMM had higher MIBS scores, particularly on the LA subscale, which was partially mediated by NICU admission. Psychotherapy to support parent-infant relationships is necessary for women with SMM.

Lifetime discrimination in low to middle income mothers and cellular aging: A prospective analysis

BackgroundExperiences of discrimination on the basis of race, ethnicity, and other characteristics are associated with adverse health outcomes, including elevated rates of morbidity in later life and earlier mortality. Acceleration of biological aging is a plausible pathway linking discrimination to disease risk. The objective of this study was to examine the relationship of self-reported lifetime and everyday discrimination to women's telomere length several years after birth of a child in a longitudinal cohort study. MethodsThe Community Child Health Network (CCHN) conducted a community-based participatory research project focused on racial, ethnic, and socioeconomic disparities in maternal and child health. Data for the current substudy are from a longitudinal cohort study in 3 of the 5 project sites. This multi-site community-based longitudinal study was conducted in Lake County, IL north of Chicago, Washington, D.C., and rural North Carolina. Participants were low to middle-income mothers (N = 103) with a primary identity of Hispanic/Latina, Black, or non-Hispanic White who rated their experience of everyday and lifetime discrimination during an at-home interview one-month postpartum. Buccal samples were collected to assay buccal cell telomere length several years later when a consecutive child was 3–5 years of age. Telomere length derived from buccal cells was used as a biomarker indicating cellular aging and a risk factor for age-related disease. ResultsMothers (18–39 years old) who reported higher lifetime discrimination had shorter telomere length an average of 5.6 years later (B = −0.22 [SE = 0.04], p < 0.001). Mother's reports of everyday discrimination were not significantly related to telomere length (0.01[0.01], p = 0.15). ConclusionsThese findings suggest that lifetime exposure to discrimination, but not necessarily current reports of everyday discrimination, may increase biological aging as indicated by shorter buccal cell telomere length, providing evidence of a plausible route through which discrimination contributes to increased risk for earlier onset aging and age-related disease in women.

Non-Cholesterol Sterols in Breast Milk and Risk of Allergic Outcomes in the First Two Years of Life.

This study aimed to explore associations between non-cholesterol sterol concentrations in breast milk and allergic outcomes in children aged two. Data from the KOALA Birth Cohort Study, the Netherlands, were used. Non-cholesterol sterols were analyzed by gas–liquid chromatography–mass spectrometry in breast milk sampled one-month postpartum (N = 311). Sterols were selected for each allergic outcome, i.e., eczema, wheeze, and allergic sensitization, prior to analyses. Associations between the selected sterols with allergic outcomes were analyzed using multiple logistic regression to calculate odds ratios (ORs). The odds of eczema in the first two years of life were lower with higher concentrations of cholestanol (OR (95%CI): 0.98 (0.95; 1.00), p = 0.04), lanosterol (0.97 (0.95; 1.00), p = 0.02), lathosterol (0.93 (0.87; 0.99), p = 0.02), and stigmasterol (0.51 (0.29; 0.91), p = 0.02) in breast milk sampled one-month postpartum. None of the sterols were associated with wheeze in the first two years of life. The odds of allergic sensitization at age two were lower with higher concentrations of campesterol in breast milk (OR (95%CI): 0.81 (0.70; 0.95), p = 0.01). In conclusion, our data suggest that exposure to higher non-cholesterol sterol concentrations in breast milk may indeed be associated with the prevention of allergic outcomes in the first two years of life.

Psychological impacts of the COVID-19 pandemic on one-month postpartum mothers in a metropolitan area of Japan

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has recently become the most important issue in the world. Very few reports in Japan have examined the impact of the COVID-19 pandemic on peripartum mental health. We examined the status of postpartum mental health before and during COVID-19 pandemic from a consecutive database in a metropolitan area of Japan.MethodsThe subjects were women who had completed a maternity health check-up at a core regional hospital in Yokohama during the period from April 1, 2017, to December 31, 2020. We collected the subjects’ scores for the Edinburgh Postnatal Depression Scale (EPDS) and the Mother-to-Infant Bonding Scale (MIBS) at 1 month postpartum. The subjects were divided into four groups (three Before COVID-19 groups and a During COVID-19 group). MANOVA and post-hoc tests were used to determine mental health changes in the postpartum period among the four groups.ResultsThe Before and During COVID-19 groups contained 2844 and 1095 mothers, respectively. There were no significant difference in the total scores of the EPDS and MIBS among the four groups. However, the EPDS items related to anxiety factors were significantly higher and the EPDS items related to anhedonia and depression factors (excluding thoughts of self-harm) were significantly lower in the During COVID-19 group.ConclusionThe EPDS scores changed in connection with the COVID-19 pandemic. Anxiety, which represent hypervigilance, was significantly higher and anhedonia and depression were significantly lower in the During COVID-19 group. Our results may reflect COVID-19-related health concerns and a lack of social support caused by the COVID-19 pandemic.

Decreased Physical Activity during Pregnancy Is Associated with Excessive Gestational Weight Gain.

The majority of pregnant women in Taiwan are not considered physically active. During pregnancy, many women decrease their physical activity levels when compared to pre-pregnancy. The purpose of this study was to examine the association between decreased physical activity from pre-pregnancy to pregnancy and excessive gestational weight gain (GWG). This study applied a prospective panel design. Recruitment was conducted at six medical facilities in Taiwan and lasted from August 2016 to April 2017. Physical activity levels were determined both before and during pregnancy using the International Physical Activity Questionnaire—Short Form, with data subsequently being transformed into METs-min/week. Excessive GWG was determined based on the body mass index (BMI) specific GWG range. We recruited 747 pregnant women in their second trimester and followed them through to one-month postpartum. About 40% of participants (41.2%) exhibited excessive GWG. Physical activity decreased from an average of 2261 (SD = 3999) to 1252 (SD = 2258) METs-min/week from pre-pregnancy to pregnancy (p < 0.0001). Controlling for age and pre-pregnancy BMI, a logistic regression model revealed that a decline in physical activity of > 4000 METs-min/week from pre-pregnancy to pregnancy was associated with an increased risk for excessive GWG (OR = 2.83, 95% CI: 1.27–4.43). A substantial decrease in physical activity from pre-pregnancy to pregnancy was a risk factor for excessive GWG. Although most women decreased their physical activity during pregnancy, only those pregnant women who were physically active pre-pregnancy could show the kind of large decrease that resulted in excessive GWG. Health professionals should continue to develop strategies for counteracting the problematic trend of decreasing PA during pregnancy among low-risk pregnant women.

Metal exposure and bone remodeling during pregnancy: Results from the PROGRESS cohort study

Pregnancy is characterized by high bone remodeling and might be a window of susceptibility to the toxic effects of metals on bone tissue. The aim of this study was to assess associations between metals in blood [lead (Pb), cadmium (Cd)and arsenic (As)] and bone remodeling during pregnancy. We studied pregnant woman from the PROGRESS Cohort (Programming Research in Obesity, Growth, and Environment and Social Stress). We measured concentrations of metals in blood and obtained measures of bone remodeling by quantitative ultrasound (QUS) at the radius in the second and third trimester of pregnancy. To account for chronic lead exposure, we measured lead in tibia and patella one-month postpartum with K-shell X-ray fluorescence. We assessed cross-sectional and longitudinal associations between multiple-metal concentrations and QUS z-scores using linear regression models and linear mixed models adjusted for potential confounders. Third trimester blood Cd concentrations were marginal associated with lower QUS z-scores [-0.16 (95% CI: −0.33, 0.007); P-Value = 0.06]. Mixed models showed that blood Cd was longitudinally and marginally associated with an average of −0.10 z-score (95% CI: −0.21, 0.002; P-Value = 0.06) over the course of pregnancy. Associations for Pb and As were all inverse however none reached significance. Additionally, bone Pb concentrations in patella, an index of cumulative exposure, were significantly associated with −0.06 z-score at radius (95% CI: −0.10, −0.01; P-Value = 0.03) during pregnancy. Pb and Cd blood levels are associated with lower QUS distal radius z-scores in pregnant women. Bone Pb concentrations in patella were negatively associated with z-score at radius showing the long-term effects of Pb on bone tissue. However, we cannot exclude the possibility of reverse causality for patella Pb and radius z-score associations. Our results support the importance of reducing women’s metal exposure during pregnancy, as metals exposure during pregnancy may have consequences for bone strength later in life.The main finding of our study is the association between Cd blood levels and radius z-score during pregnancy. Bone lead in patella was also negatively associated with radius z-scores.

Prenatal blood lead levels and reduced preadolescent glomerular filtration rate: Modification by body mass index

BackgroundFor the developing kidney, the prenatal period may represent a critical window of vulnerability to environmental insults resulting in permanent nephron loss. Given that the majority of nephron formation is complete in the 3rd trimester, we set out to test whether 1) prenatal lead exposure is associated with decreased preadolescent kidney function and 2) whether preadolescent obesity acts synergistically with early life lead exposure to reduce kidney function. MethodsOur study included 453 mother–child pairs participating in the PROGRESS birth cohort. We assessed prenatal blood lead levels (BLLs) in samples collected in the 2nd and 3rd trimesters and at delivery, as well as tibial and patellar bone lead measures assessed one-month postpartum. Preadolescent estimated glomerular filtration rate (eGFR) was derived from serum levels of creatinine and/or cystatin C measured at age 8–12 years. We applied linear regression to assess the relationship between prenatal bone and BLL with preadolescent eGFR, and adjusted for covariates including age, sex, BMI z-score, indoor tobacco smoke exposure, and socioeconomic status. We also examined sex-specific associations and tested for effect modification by BMI status. ResultsWe observed null associations between prenatal lead exposure and eGFR. However, in interaction analyses we found that among overweight children, there was an inverse association between BLL (assessed at 2nd and 3rd trimester and at delivery) and preadolescent eGFR. For example, among overweight participants, a one ln-unit increase in 2nd trimester BLL was associated with a 10.5 unit decrease in cystatin C-based eGFR (95% CI: −18.1, −2.8; p = 0.008). Regardless of lead exposure, we also observed null relationships between BMI z-score and eGFR overall, as well as among overweight participants. However, among participants with preadolescent obesity, we observed a significant 5.9-unit decrease in eGFR. We observed no evidence of sex-specific effects. ConclusionsOur findings, if confirmed in other studies, suggest a complex interplay between the combined adverse effects of adiposity and perinatal lead exposure as they relate to adolescent kidney function. Future studies will assess kidney function and adiposity trajectories through adolescence to better understand environmental risk factors for kidney function decline.

Brucellar Pericarditis: You Can Get from Your Pet!

Background: Brucellosis is a worldwide zoonotic systemic infectious disease with a diverse clinical presentation. Cardiovascular affections are not frequent, and the main cardiac manifestation of Bru-cellosis is endocarditis. Pericarditis without endocarditis is extremely rare. Case Presentation: In this case report, we present an exceptional case of pericarditis caused by Brucellosis in the absence of concomitant endocarditis in a 30-year-old woman, one-month postpar-tum, from the countryside. The lady presented with night sweats, mild fever, weight loss, dyspnea and chest pain. A diagnostic workup revealed positive titers for Brucella, indicating that the patient was suffering from systemic Brucellosis. The patient recovered completely, after receiving appropri-ate oral non-steroidal anti-inflammatory and dual antibiotics treatment, and responded well without any sign of relapse during a six month follow-up period. Conclusion: Pericarditis can occur during Brucellosis as an isolated cardiac symptom. Brucellar per-icarditis should always be kept in mind in patients with pericarditis and pericardial effusion, alt-hough the prevalence of pericarditis in Brucellosis is very low.

Risk of postpartum depression and very early child mistreatment among mothers reporting higher autistic traits: Evidence from the Japan Environment and Children's Study

BackgroundLittle is known about how mothers who report higher autistic traits face new parenthood. This study examined the association between antenatal non-clinical autistic traits and the risks of both postpartum depression (PPD) and child mistreatment at one-month postpartum and if these associations were mediated by preexisting social support. MethodsParticipants included 73,532 singleton mothers without histories of psychiatric conditions from the Japan Environment and Children's Study, a nationwide birth cohort. Autistic traits were measured during the second/third trimesters using the short-version of the Autism Quotient-Japanese version. Participants were classified into three groups (i.e., typical-range, moderate-range, and high-range). PPD was measured using the Japanese version of the Edinburgh Postnatal Depression Scale, while participants self-reported experiences of child mistreatment (i.e., hit or shake the child); both assessments were conducted at one-month postpartum. Individual social support was reported during pregnancy. Data analyses were conducted through Poisson regressions. ResultsA total of 7,147 (9.7%) participants reported PPD, while 12,994 (17.7%) reported child mistreatment at one-month postpartum. Autistic traits were associated with increased PPD risk (adjusted-relative risk [aRR] =1.74, 95%CI=1.64–1.84 for moderate-range; aRR=2.33, 2.13–2.55 for high-range) and child mistreatment (aRR=1.19, 1.13–1.24 for moderate-range; aRR=1.39, 1.28–1.50 for high-range) independently of confounders. Social support mediated 26–31% of these associations for moderate/high-range groups (both risks). LimitationsSelf-reported measurements were used. ConclusionsMothers who reported moderate-to-high autistic traits in the general population were vulnerable to PPD and newborn mistreatment at one-month postpartum, which was partially explained by the lack of social support during pregnancy.

Effect of Maternal Diet and Milk Lipid Composition on the Infant Gut and Maternal Milk Microbiomes.

Inter-subject variability in human milk microbiome is well known; however, its origins and possible relationship to the mother’s diet are still debated. We investigated associations between maternal nutrition, milk fatty acids composition and microbiomes in mother–infant dyads. Breast milk and infant fecal samples were collected across three time points (one week, one month and three months postpartum) from 22 mother–infant pairs. Food frequency questionnaires for the months of pregnancy and three months postpartum were collected. Milk fatty acids were analyzed by GC–MS and the microbiome in breast milk and infant feces was determined by 16S rRNA sequencing. Statistical interactions were computed using Spearman’s method and corrected for multiple comparisons. We found significant negative correlation between Streptococcus relative abundance in maternal milk and intake of unsaturated fatty acids and folic acid at one month postpartum. At three months postpartum, vitamin B-12 consumption was significantly associated with a single operational taxonomic unit belonging to Streptococcus. Comparison between milk microbiome and lipid composition showed, one-month postpartum, significant negative correlation between Streptococcus relative abundance and the abundance of oleic acid. Additional correlations were detected between Staphylococcus hominis and two medium-chain saturated fatty acids. Our results reinforce the hypothesis that maternal nutrition may affect milk microbiome.

The effects of a hospital-based perinatal breastfeeding program on exclusive breastfeeding in Taiwan: a quasi-experimental study

Objective: To examine if a perinatal breastfeeding program would improve the exclusive breastfeeding rate at a baby-friendly hospital. Background: The Ten Steps to Successful Breastfeeding and Baby-Friendly Hospital Initiative have been widely used to improve breastfeeding outcomes worldwide. A hospital-based multi-strategy intervention may provide an opportunity to increase breastfeeding in different countries. Study design and methods: The study used a quasi-experimental design. Data was collected in a Baby Friendly hospital. A total of 60 mother-infant dyads were included. The experimental group took part in the multi-component perinatal breastfeeding program, while the control group received routine care. The multi-strategy program included prenatal breastfeeding education, birth kangaroo mother care (skin-to-skin contact and non-separation practices) at first breastfeed, continuous 24-hour rooming-in, ongoing kangaroo mother care with breastfeeding on cue, and hospital support visits. The exclusive breastfeeding rate was measured at hospital discharge, and one-month postpartum. Results: The mothers who participated in the intervention had a greater exclusive breastfeeding rate at hospital discharge and one month postpartum than those in the control group. In the experimental group, 90% of the infants completed the first feeding within two hours after birth. At discharge, 93.3% of the mothers in the experimental group and 53.3% in the control group were exclusively breastfeeding. At one month postpartum, 83.3% of the mothers in the experimental group and 36.7% in the control group were still exclusively breastfeeding. Discussion: The intervention program used in the current study is different to previous studies. The current intervention not only included prenatal education and postpartum support, but also included birth kangaroo mother care at first breastfeed and ongoing kangaroo mother care with breastfeeding on cue. Breastfeeding should be promoted through perinatal comprehensive clinical and social support starting in the prenatal period and continuing through intrapartal, postpartum, and follow-up periods. Conclusion: This study was the first study to use a hospital-based multi-strategy intervention including the non-separation of mother-infant dyads and other breastfeeding support for mothers in Taiwan. The program was associated with a significant improvement in the exclusive breastfeeding rate at one month postpartum.

The effects of a hospital-based perinatal breastfeeding program on exclusive breastfeeding in Taiwan: a quasi-experimental study

Objective: To examine if a perinatal breastfeeding program would improve the exclusive breastfeeding rate at a baby-friendly hospital. Background: The Ten Steps to Successful Breastfeeding and Baby-Friendly Hospital Initiative have been widely used to improve breastfeeding outcomes worldwide. A hospital-based multi-strategy intervention may provide an opportunity to increase breastfeeding in different countries. Study design and methods: The study used a quasi-experimental design. Data was collected in a Baby Friendly hospital. A total of 60 mother-infant dyads were included. The experimental group took part in the multi-component perinatal breastfeeding program, while the control group received routine care. The multi-strategy program included prenatal breastfeeding education, birth kangaroo mother care (skin-to-skin contact and non-separation practices) at first breastfeed, continuous 24-hour rooming-in, ongoing kangaroo mother care with breastfeeding on cue, and hospital support visits. The exclusive breastfeeding rate was measured at hospital discharge, and one-month postpartum. Results: The mothers who participated in the intervention had a greater exclusive breastfeeding rate at hospital discharge and one month postpartum than those in the control group. In the experimental group, 90% of the infants completed the first feeding within two hours after birth. At discharge, 93.3% of the mothers in the experimental group and 53.3% in the control group were exclusively breastfeeding. At one month postpartum, 83.3% of the mothers in the experimental group and 36.7% in the control group were still exclusively breastfeeding. Discussion: The intervention program used in the current study is different to previous studies. The current intervention not only included prenatal education and postpartum support, but also included birth kangaroo mother care at first breastfeed and ongoing kangaroo mother care with breastfeeding on cue. Breastfeeding should be promoted through perinatal comprehensive clinical and social support starting in the prenatal period and continuing through intrapartal, postpartum, and follow-up periods. Conclusion: This study was the first study to use a hospital-based multi-strategy intervention including the non-separation of mother-infant dyads and other breastfeeding support for mothers in Taiwan. The program was associated with a significant improvement in the exclusive breastfeeding rate at one month postpartum.

MON-351 Early Diagnosis and Management of Bilateral Transient Osteoporosis of the Hip in Pregnancy

Introduction: Transient osteoporosis of the hip (TOH) in pregnancy is a rare and under-reported condition. It is clinically characterized by a sudden onset of hip pain in young females without any history of systemic disorders or traumatic injuries (1). Bilateral involvement of the hips, such as in this case report, is less common than unilateral involvement. Clinical Case: A 33 year old G2P1 female presented to the hospital at 30 weeks gestation for described sharp, bilateral inguinal pain, greater on the left than right, worse with movement, and with progressive difficulty ambulating, of three weeks duration. She had no significant PMH, notably denying thyroid or calcium disorder, nephrolithiasis, osteoporosis, or steroid treatment. She denied tobacco, alcohol, or illicit substance usage. She only took prenatal vitamins. On physical examination, she had reduced active and passive range of motion of both hips, but normal muscle strength and no signs of infection or neurological deficits. Labs including CMP, LFTs, and TFTs were within normal range. 24 hour urine free cortisol was 54 mcg/24h (normal 3.5-45mcg/24h); repeat post-partum was 21 mcg/24h. 25OH-D was 18.3 ng/mL. MRI without contrast demonstrated “extensive abnormal marrow edema within the left femoral head and neck and small effusion, suspicious for transient osteoporosis of the hip. A subtle small focus of edema on the right was also noted. No discrete fracture line or subchondral collapse was noted.”The patient was managed conservatively with analgesics, thromboprophylaxis, and education regarding reduction of weight bearing activities, rest, and mobility aids with crutches. She was started on vitamin D. Her bilateral hip pain resolved by the 38th week. She had an uncomplicated cesarean delivery at 39 weeks to a healthy male neonate. At the one-month postpartum visit, she was ambulating independently without difficulty. She denied further pain, and passive and active ROM were intact without tenderness. Conclusion: TOH in pregnancy is usually a self-limiting disorder with no obvious etiology (2). It can present unexpectedly in the third trimester or early postpartum period in a healthy female with an otherwise uneventful pregnancy. In rare instances where fractures of the affected hip occur, surgical intervention may be necessary. MRI has become the diagnostic tool of choice for early diagnosis of TOH. Early diagnosis and optimal management are essential to prevent major complications such as traumatic fractures and deep vein thrombosis, as well as to prevent stress for the mother during the course of pregnancy.

Paternal Involvement and Adverse Birth Outcomes in South Gujarat, India.

Background and Objectives:While the impact of maternal factors on birth outcomes are widely reported, the extent to which paternal involvement and varying cultural family dynamics influence birth outcomes particularly in an international context, remain understudied. The purpose of this study was to assess the relationship between paternal involvement and adverse birth outcomes in South Gujarat, India.Methods:An in-person questionnaire was administered to adult women at delivery or during the one-month postpartum visit at New Civil Hospital, in South Gujarat, India between May and June 2016 to assess level of paternal support and attendance at prenatal appointments and household structure. Pregnancy variables including birthweight and gestational age at delivery were collected from maternal and newborn record/chart review. Chi-square and t-test were used to assess demographics, as appropriate. Logistic regression was used to examine the association between paternal involvement and pregnancy birth outcomes.Results:Of the 404 infants born during the study period, 26.7% were premature (<37 weeks gestation) and 29% were of low birth weight (<2500g). More than 40% of the women surveyed reported their in-laws were the primary household decision-makers; however, those who reported high paternal attendance were less likely to report in-laws as the primary decision-maker (p=0.03). Adjusted logistic regression analysis indicated the odds of delivering a low birth weight infant were greater among mothers who reported low paternal support and low paternal attendance at prenatal visits (OR=2.99 (95% Confidence Interval (CI): 1.84-4.86) and OR=2.16 (95% CI: 1.35-3.47), respectively).Conclusion And Global Health Implications:Low paternal support during pregnancy may be a missed opportunity to increase healthy practices during pregnancy as well as decrease the risks associated with limited social support during pregnancy. It is important to consider varying socio-cultural family dynamics in different populations and how they may influence paternal involvement during pregnancy.

A childhood immunization education program for parents delivered during late pregnancy and one-month postpartum: a randomized controlled trial

BackgroundImproved immunization rates have reduced the incidence of vaccine-preventable diseases (VPDs) in advanced nations. Japan’s unique vaccination system classifies vaccines into routine vaccines ostensibly required under the Preventive Vaccination Law and recommended but optional vaccines, although all vaccines are in fact voluntary. In Japan, low immunization rates, particularly for optional vaccines, have resulted in high rates of sequelae and death. The decision as to whether a child will receive a vaccine depends on the parents, who must obtain information, make inquiries, and make the required payment, the last of which is a major barrier. This randomized, controlled trial was conducted to evaluate the effectiveness of an immunization education program designed to meet mothers’ needs.MethodsThis randomized controlled trial assigned pregnant women to intervention or control groups. The intervention was individual education sessions involving the children’s fathers in shared decision-making on whether or not to immunize their child. A survey was conducted before and after the intervention. Data were analyzed using the intention-to-treat principle.ResultsOf 225 pregnant women, 175 (78%) participated and 171 replied to the post-survey. At age 3 months, intervention infants had higher self-reported immunization rates for hepatitis B virus vaccine (76% vs. 49%; P < 0.001) and rotavirus vaccine (84% vs. 68%; P = 0.019) than control group infants. The percentage of parents intending to vaccinate their infants was higher in the intervention group (77% vs. 52%; P < 0.01). Improvements in scores for basic knowledge (mean [SD]: 5.5 [3.6] vs. 3.0 [3.8], range: 10–30; P < 0.001), advanced knowledge (mean [SD]: 5.1 [2.4] vs. 2.8 [2.5], range: 5–15; P < 0.001), and health literacy regarding immunization (mean [SD]: 0.5 [0.8] vs. 0.2 [0.6], range: 1–5; P < 0.01) were higher in the intervention group. The rate of decision making by both parents (68% vs. 52%; P < 0.05) was higher in the intervention group.ConclusionsOur findings confirmed the program’s effectiveness. The intervention improved immunization rates, the percentage of parents intending to vaccinate their infants and knowledge scores. Interventions which directly and indirectly involved fathers in shared decision-making on whether to immunize their child were effective, as were individualized interventions that provided parents with access to up-to-date information.Trial registrationUMIN000012575. Registered 14 December 2013 (The study was prospectively registered).

Postpartum radiographic changes in pelvic morphology and its relation with symptoms of pregnancy-related symphysis pain

Introduction: The etiology of pregnancy-related pubic symphysis pain (PSP) is usually considered as the change in pelvic biomechanics during pregnancy. However, the biomechanical changes that occur during puerperium, and the difference of radiographic dimensions in women with different types of PSP remains unknown. Materials and Methods: Fifty women with self-reported PSP were included. Two conventional X-ray radiographic dimensions obtained on the delivery day and one-month postpartum were compared by using paired t-test. Based on the self-reported VAS at one-month postpartum, variables between pain-recovery and non-recovery groups were also compared. Results: The comparison between pre- and post-values indicates a reduced distance between FLAMs (239.1 vs. 237.0 mm), PS separation (7.9 vs. 6.5 mm), and PS translation (4.1 vs. 3.1 mm). No significant differences were observed in the distance between FLAMs, width of PS separation, or pubic symphysial surface (PSS) angle between the recovery and non-recovery groups. However, the non-recovery group exhibited a significantly large change in PS translation at one-month postpartum than the recovery group (-1.8 vs. -1.1 mm). Conclusions: The pelvic radiography demonstrated a 'closure' alteration in the pelvic cavity diameter onemonth postpartum with a decrease in the distance between FLAMs and shortened PS separation. The difference in radiographic diameters between groups was not clearly evident.